Neuro-AIDS Consortium Works to Improve Diagnosis and Treatment in Asia

January 2004—The Asia-Pacific Neuro-AIDS Consortium (APNAC) was established to improve the diagnosis and management of neurological complications of HIV infection (neuro-AIDS) in the Asia-Pacific region. Thirty percent of people living with HIV/AIDS will experience some type of neurological illness, such as cryptococcal meningitis, cerebral toxoplasmosis, and dementia. Common and often debilitating, neuro-AIDS can be difficult to diagnose and treat and presents a special challenge in resource-poor countries where necessary diagnostic equipment like CT Scanners and MRIs are scant to non-existent.

In October 2002, the Neurological Working Group of the National Centre in HIV Epidemiology and Clinical Research in Sydney, Australia, convened a meeting of clinicians from nine countries in the region. General physicians, as well as specialists in neurology, infectious disease, and pediatric neurology discussed commonly encountered neurological illnesses and the state of diagnostic and treatment infrastructure in their countries.

The Asia-Pacific Neuro-AIDS Consortium at their second annual meeting in Cairns, Australia, October 21-22, 2003.

It became clear that some countries lack even basic antibiotics to care for neuro-AIDS and have no diagnostic equipment, said Dr. Edwina Wright, APNAC Chairperson and an infectious disease physician at the Alfred Hospital in Melbourne. To address these shortcomings, the consortium began creating algorithms to diagnose neurological conditions in the absence of scanning equipment and established an e-mail forum in which clinicians could share and elicit advice and expertise on specific cases.

The consortium met again in October 2003 and finalized those guidelines. APNAC will publish them next year, hoping they will help resource-poor medical communities treat neuro-AIDS not just in Asia, but also in places such as Eastern Europe and Africa.

In addition, APNAC plans to monitor the effects of increased availability of antiretroviral therapy in Asia. “One of the things we feel needs to be looked at and watched carefully,” said Dr. Wright, “is what happens to people who get antiretroviral treatment and may just be developing cryptococcal meningitis, for example. Suddenly restoring their immune system may lead to a paradoxical worsening of that condition.”

Another important issue for APNAC is pediatric neuro-AIDS. A large percentage of HIV-positive children develop dementia within the first five years of their life. Because they may appear healthy, children must be closely monitored to determine if they are developing neuro-AIDS.

Beyond raising awareness and improving treatment for neuro-AIDS, Dr. Wright believes APNAC “offers a paradigm for tackling a complex problem head on by coming together to learn from colleagues on the ground.”